Causal analysis for multivariate integrated clinical and environmental exposures data.

Electronic health records (EHRs) provide a rich source of observational patient data that can be explored to infer underlying causal relationships. These causal relationships can be applied to augment medical decision-making or suggest hypotheses for healthcare research. In this study, we explored a large-scale EHR dataset on patients with asthma or related conditions (N = 14,937).

Using EMS data to explore community-level factors associated with firearm violence in North Carolina.

Background: Firearm violence is a significant public health issue. However, it is unclear if there is an association between the Social Vulnerability Index (SVI) and the intent of both fatal and nonfatal firearm injuries, and if these associations are modified by community race and ethnic composition. This study examines the association between community-level social vulnerability and firearm injury incidence in North Carolina (NC) using 2021-2022 emergency medical services (EMS) data.

Community and multisector partner engagement in US Vision Zero plan development.

Background: Vision Zero aims to eliminate serious and fatal road injuries using a Safe System approach. Safe System principles establish that safety is a shared responsibility; this involves both multisector partners and community engagement. This descriptive study explored multisector partners and community engagement in the development of municipal Vision Zero plans.

A systematic review of validity of US survey measures for assessing substance use and substance use disorders.

Background: The steep rise in substance use and substance use disorder (SUD) shows an urgency to assess its prevalence using valid measures. This systematic review summarizes the validity of measures to assess the prevalence of substance use and SUD in the US estimated in population and sub-population-based surveys.

Methods: A literature search was performed using nine online databases.

Comparative analysis of injury identification using KABCO and ISS in linked North Carolina trauma registry and crash data.

Objective: The purpose of this study was to examine differences between police-reported injury severity and trauma registry data among persons with linked records in North Carolina and quantify the degree of alignment.

Methods: We analyzed linked North Carolina trauma registry and motor vehicle crash data from 2018. Injury severity identification was assessed using police-reported 5-point scale KABCO from crash data and Injury Severity Score (ISS) from trauma records.

Public Health Involvement in United States' Vision Zero Initiatives: A Mixed-Methods Study.

Context: Vision Zero (VZ) aims to reduce fatalities and serious injuries from road traffic crashes to zero through multidisciplinary coordination. While public health officials are often recognized as critical to VZ, their involvement in VZ across the United States has not been quantified.

Objective: To explore how United States public health officials were involved in VZ development and implementation.

Racial and ethnic disparities in motor vehicle crash-related outcomes in North Carolina surrounding the COVID-19 pandemic.

Long-term impacts of the COVID-19 pandemic on racial and ethnic disparities in motor vehicle crash (MVC) injuries and death are poorly understood. This study aimed to characterize trends and investigate the heterogeneity of MVC-related disparities in North Carolina across several data sources. Crash reports, emergency department visit records, and death certificates from 2018 to 2021 were used to calculate monthly population-rates of MVC-related public health outcomes.

Evaluating robustness of a generalized linear model when applied to electronic health record data accessed using an Open API.

The Integrated Clinical and Environmental Exposures Service (ICEES) provides open regulatory-compliant access to clinical data, including electronic health record data, that have been integrated with environmental exposures data. While ICEES has been validated in the context of an asthma use case and several other use cases, the regulatory constraints on the ICEES open application programming interface (OpenAPI) result in data loss when using the service for multivariate analysis. In this study, we investigated the robustness of the ICEES OpenAPI through a comparative analysis, in which we applied a generalized linear model (GLM) to the OpenAPI data and the constraint-free source data to examine factors predictive of asthma exacerbations.

Structural Racism and Pedestrian Safety: Measuring the Association Between Historical Redlining and Contemporary Pedestrian Fatalities Across the United States, 2010‒2019.

To examine the association between historical redlining and contemporary pedestrian fatalities across the United States. We analyzed 2010-2019 traffic fatality data, obtained from the Fatality Analysis Reporting System, for all US pedestrian fatalities linked by location of crash to 1930s Home Owners' Loan Corporation (HOLC) grades and current sociodemographic factors at the census tract level. We applied generalized estimating equation models to assess the relationship between the count of pedestrian fatalities and redlining.

Mixed-methods approach to describing Vision Zero initiatives in United States' municipalities.

Vision Zero (VZ) aims to reduce fatalities and serious injuries from road traffic crashes to zero through a Safe Systems approach. Little is known about the extent of uptake of VZ in the United States (US), or the attributes and functioning of the initiatives. Using a mixed-methods design, our objectives were to describe the status of VZ implementation and characteristics of those initiatives among US municipalities.

A Novel Vision Zero Leadership Training Model to Support Collaboration and Strategic Action Planning.

While collaboration and cooperation are regarded as foundational to Vision Zero (VZ) and Safe Systems initiatives, there is little guidance on structuring VZ collaboration, conducting collaborative goal setting, and aligning tangible action across organizations. As part of a larger VZ mutual learning model, we developed a VZ Leadership Team Institute to support communities in collaborative VZ strategic planning and goal setting. The purpose of this paper is to describe the development and evaluation of the Institute, which can serve as a foundation for other initiatives seeking to move VZ planning and implementation forward in a collaborative, systems-aware manner.

Mixed method assessment of built environment and policy responses to the COVID-19 pandemic by United States municipalities focusing on walking and bicycling actions.

Introduction: In 2020, the COVID-19 pandemic prompted community officials to initiate local level environmental and policy changes to slow the spread of infection and provide more opportunities for outdoor recreation. Changes in both regards could positively or negatively impact walking and bicycling. Using a mixed methods approach, the purpose of this United States-based study was to systematically describe municipal response to the pandemic at the community level through environmental and policy changes that may have impacted walking and bicycling.

The role of inexperience in motorcycle crashes among novice and returning motorcycle riders.

Objectives: To examine the crash trends of younger novice and older novice/returning motorcycle riders.

Methods: We used a linked database of North Carolina crash and licensing data from 1991 through 2018 that included 103,142 younger novice and 98,540 older novice/returning motorcycle riders. We examined the percent of riders who crashed each month after obtaining a motorcycle license.

Database selection matters: A case study in child restraint use and injury patterns using North Carolina motor vehicle traffic crash report and trauma registry data.

Objective: While proper restraint use is protective against motor traffic vehicle crash (MVTC)-associated morbidity and mortality, it is inconsistently measured across health and MVTC data sources. This project addresses this gap by assessing differences in child restraint measures between two North Carolina (NC) datasets and comparing the utility of these sources to evaluate patterns of child restraint use and associated health outcomes.

Methods: We analyzed 2018 NC MVTC and NC Trauma Registry (NCTR) data for children ≤15 years old, both separately and as linked MVTC-NCTR records.

Supporting Kids' Active Travel during the Pandemic: Milwaukee SRTS Program.

The Milwaukee Safe Routes to School (SRTS) Program, a partnership between the city of Milwaukee Department of Public Works and the Wisconsin Bike Federation continued their commitment to children's active travel during the COVID-19 pandemic through offering "walk audit"-style traffic safety community walks and a variety of other biking and walking programs in neighborhoods with majority Black or Latine residents. These efforts included public involvement activities to discuss and incorporate preferences for planned infrastructure improvements; urban summer bicycle camps for kids; and support for teachers as SRTS champions. Staff made modifications such as conducting programming outdoors; modifying materials and facilitation methods to support physical distancing; providing face coverings and minimizing touching equipment.

Open Application of Statistical and Machine Learning Models to Explore the Impact of Environmental Exposures on Health and Disease: An Asthma Use Case.

ICEES (Integrated Clinical and Environmental Exposures Service) provides a disease-agnostic, regulatory-compliant approach for openly exposing and analyzing clinical data that have been integrated at the patient level with environmental exposures data. ICEES is equipped with basic features to support exploratory analysis using statistical approaches, such as bivariate chi-square tests. We recently developed a method for using ICEES to generate multivariate tables for subsequent application of machine learning and statistical models.

Examining the Effect of Pedestrian Crashes on Vulnerable Populations in North Carolina.

Background: Over the last several years, pedestrian fatalities have increased in North Carolina; however, fatalities represent a small proportion of the total number of nonfatally injured pedestrians. Therefore, we linked statewide motor vehicle crash (MVC) and emergency department (ED) visit data to better understand the circumstances and characteristics of pedestrians treated in North Carolina emergency departments (EDs) for injuries related to crashes.

Methods: We linked information for pedestrians and bicyclists from 2017 North Carolina police-reported MVCs to population-based ED visit data using hierarchical deterministic methods.

The impact of the COVID-19 pandemic on the utilization of emergency department services for the treatment of injuries.

Context: The global COVID-19 pandemic has had a major impact on the utilization of healthcare services; however, the impact on population-level emergency department (ED) utilization patterns for the treatment of acute injuries has not been fully characterized.

Objective: This study examined the frequency of North Carolina (NC) EDs visits for selected injury mechanisms during the first eleven months of the COVID-19 pandemic.

Methods: Data were obtained from the NC Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), NC's legislatively mandated statewide syndromic surveillance system for the years 2019 and 2020.

An approach for open multivariate analysis of integrated clinical and environmental exposures data.

The Integrated Clinical and Environmental Exposures Service (ICEES) provides regulatory-compliant open access to sensitive patient data that have been integrated with public exposures data. ICEES was designed initially to support dynamic cohort creation and bivariate contingency tests. The objective of the present study was to develop an open approach to support multivariate analyses using existing ICEES functionalities and abiding by all regulatory constraints.

Selected characteristics and injury patterns by age group among pedestrians treated in North Carolina emergency departments.

Objective: The objective of this study was to describe pedestrian demographic characteristics, crash characteristics, selected health outcomes, and injury patterns by age using linked North Carolina (NC) crash-emergency department (ED) visit data for the period October 1, 2010, to September 30, 2015.

Methods: This was a descriptive epidemiologic study. To examine both crash and health outcomes, NC pedestrian crash records were linked to statewide NC ED visit records using hierarchical deterministic methods.